Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | F4656 | TX |
NPI | 1003834193 |
---|---|
Provider Name | Robert Bruce Watson |
First Address | Lafayette, LA 70508-3870 |
Second Address | Athens, TX 75751-5610 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C23218 | (02) |